SUMMARYExtensive losses of neural tissue preclude the repair performed by means of primary anastomosis. In those cases, nerve autograft is considered as the treatment of choice. The synthetic tube constituted by polyglycolic acid is an option for nerve graft. The FK506 is an immunosuppressive agent, which increases the neural regeneration rates in vivo and in vitro. The purpose of this study was to compare, in rats, the degree of neural regeneration, by using histological analysis, a count of the number of regenerated myelinated axons, and a functional analysis, obtained by interposing the autogenous graft (group A), polyglycolic acid tube (group B) and a combination of polyglycolic acid tube with FK506 (group C) in 5-cm defects of the sciatic nerve. Neuroma formation was observed only in group A. Groups B and C presented similar histological patterns. The quantitative analysis of the number of regenerated myelinated axons has determined that: 1) group B presented, in average, a lower number when compared to the other groups; 2) there was no significant difference between control group A and group C. For functional recovery, there was no statistically significant change between the three groups, despite the qualitative and quantitative histological differences seen.

Introduction: Some studies have made use of the antioxidative capabilities of high doses of vitamins C and E with the aim of neutralizing the noxious effects of free radicals following spinal cord lesion. Objectives: To evaluate the effects of vitamins C and E, separately and together, on the functional performance of rats that were subjected to standardized spinal cord contusion. Materials and methods: Forty male Wistar rats were used, divided into four groups of 10 animals each. Group 3 received vitamin C 100 mg kg À1 day À1 intraperitoneally; Group 2 received vitamin E 100 mg kg À1 day À1 orally; Group 1 received vitamins C and E, at the same dosages; and Group 4 was the control. The vitamin therapy was administered for 1 month and then the animals were killed. A direct contusional injury was caused and functional evaluation was performed using the Basso, Beattie and Bresnahan rating scale. The rats were evaluated on the second postoperative day and weekly thereafter, until the end of the experiment. Results: The results were evaluated by means of the one-tailed, non-paired and non-parametric

Prolonged tissue compression due to sitting, lying or wearing braces in a healthy person results in discomfort and pain due to local ischemia The normal protective pathways are interrupted in paraplegics, tetraplegics, or the signals are ignored in severely debilitated, elderly or chronic ill patients. The pressure sore develops in these patients. Few papers have been done in Brazil about pressure sores, despite economic problem involved with. The purpose of this paper is to evaluate the epidemiology, treatment and complications of pressure sores in the Hospital das Clínicas (University of São Paulo) from February 1997 to March 1999 in the Orthopedics Institute. A prospective study has been done. Data were evaluated as to the gender, age, sites, classification, type of treatment employed, length of stay and complications. The treatment was evaluated by the success rate and recurrence rate . The average follow-up period was 1 year and a half, ranging from 6 months to 2 years. 77 pressure sores in 45 patients were appraised. 36 men and 9 women, age range 17-64, mean 34,78 years. Of the patients, 100% had severe spinal cord injuries, and most of them victims of gun shot (60%). 93,3% of the wound were chronic (present longer than 3 months). 77,92% were treated by surgical procedures, and most of them with myocutaneous flaps (45%). The success rate changed with the site of the lesion: 80% trochanter, 84% sacrum and 66,6% ischium. The recurrence rate was 25%. The complication rate also changed with the site of the lesion: 84% trochanter, 64% sacrum and 50% ischium.

Study design: Experimental, controlled, animal study. Objectives: To evaluate the influences of antidepressant treatment, treadmill gait training and a combination of these therapies in rats with experimental, acute spinal cord injury (SCI). Setting: Brazil. Methods: 48 Wistar rats were given standardized SCI; rats were then randomly assigned to four treatment groups: (1) motor rehabilitation therapy for 1 hour daily (gait training); (2) daily treatment with the antidepressant, fluoxetine (0.3 ml per 100 g intraperitoneally), beginning 24 h after the trauma; (3) combined fluoxetine treatment and gait training, or (4) untreated (controls). Neurological recovery was tested with the Basso, Beattie and Bresnahan (BBB) scale at 2, 7, 14, 21, 28 ,35 and 42 days after injury. Moreover, on day 42, all rats underwent a motor-evoked potential test (MEP); then, after euthanasia, histopathological evaluation was conducted in the area of SCI. Results: Based on the BBB scale, the combined treatment group showed significantly greater improvement compared with the other three groups, from the 14th to the 42nd day of observation. The MEP revealed that all treated groups showed significant improvement compared with the control group (Po0.02 for latency and Po0.01 for amplitude). Conclusion: Our results indicated that a combination of antidepressant and treadmill gait training was superior to either treatment alone for improving functional deficits in rats with experimental, acute SCI.

Background: Epidemiological features of spinal cord injury (SCI) have been changing over the last decades. We evaluated the contemporary trends in the epidemiology of traumatic SCI patients from a rehabilitation center. Methods: In a cross-sectional study, a consecutive series of 348 patients with traumatic SCI were evaluated. Variables were collected through an epidemiological form, which included gender, age at injury, duration and cause of SCI. We investigated SCI epidemiological trends over time including the association between gender and age at injury with SCI features such as etiology, injury severity and level. Results: The mean age at SCI has increased from 26.0 ± 11.8 in patients with SCI before 2003 to 37.9 ± 15.7 in those with SCI after 2009 (p < 0.001). Gunshot wounds were the main cause of injury in patients with SCI before 2003, dropping from 40.6 to 16.9% after 2009 and being surpassed by road traffic injuries (38.6%) and falls (31.4%) after 2009 (p < 0.001). Gender, SCI severity and level have not changed significantly over the time. Conclusions: There was a major increase in the average age of patients as well as changes in the etiology of SCI over the past fifteen years, including a significant decrease in gunshot wounds and an increase in the frequency of road traffic injuries and falls. These changes and accompanying risk factors must be taken into consideration when planning measures to prevent SCI.

Lead poisoning can result in severe clinical disorders that require rapid treatment. In this case, both clinical and surgical treatments led to complete resolution of the symptoms.

Study design: Experimental, controlled, animal study. Objectives: To evaluate the functional effect of hyperbaric oxygen therapy administered shortly, one day after, and no intervention (control) in standardized experimental spinal cord lesions in Wistar rats. Setting: São Paulo, Brazil. Methods: In all, 30 Wistar rats with spinal cord lesions were divided into three groups: one group was submitted to hyperbaric oxygen therapy beginning half an hour after the lesion and with a total of 10 one-hour sessions, one session per day, at 2 atm; the second received the same treatment, but beginning on the day after the lesion; and the third received no treatment (control). The Basso, Beattie and Bresnahan scales were used for functional evaluation on the second day after the lesion and then weekly, until being killed 1 month later. Results: There were no significant differences between the groups in the functional analysis on the second day after the lesion. There was no functional difference comparing Groups 1 and 2 (treated shortly after or one day after) in any evaluation moment. On the 7th day, as well as on the 21st and 28th postoperative days, the evaluation showed that Groups 1 and 2 performed significantly better than the control group (receiving no therapy). INTRODUCTIONClinical and experimental researches on spinal cord trauma have raised several hypotheses with regard to the pathophysiology of secondary injury that occurs immediately after the initial injury (primary). Most current efforts are directed to minimizing this type of injury, by acting directly on its causes. Recent studies 1,2 indicate that the process is characterized by an initial ischemia (affecting mainly the gray matter), extending rostrally and caudally to the lesion. At this point, the decrease in oxygen and nutrients supply to the cells reduces the amount of available ATP, causing a malfunction of the electrolyte pumps in the cell membrane, resulting in changes in the intra-and extracellular ionic concentrations. 3,4 This process is responsible for edema and cell death and for the secretion of aminoacidic neurotransmitters, for example, the glutamate. 5 The decrease in ATP also stimulates the glycolytic pathway, increasing lactate and decreasing the local pH, which results later in vasodilation and increased blood flow, contributing to the formation of free radicals, 6 and causing cell death. Although these processes occur mainly in the gray matter, the release of lytic enzymes and free radicals eventually damages the surrounding white matter. These metabolic products also cause inflammation and demyelination. 1

Hyaline cartilage covers joint surfaces and plays an important role in reducing friction and mechanical loading on synovial joints such as the knee. This tissue is not supplied with blood vessels, nerves or lymphatic circulation, which may be one of the reasons why joint cartilage has such poor capacity for healing. Chondral lesions that reach the subchondral bone (osteochondral lesions) do not heal and may progress to arthrosis with the passage of time. In young patients, treatment of chondral defects of the knee is still a challenge, especially in lesions larger than 4 cm. One option for treating these patients is autologous chondrocyte transplantation/implantation. Because this treatment does not violate the subchondral bone and repairs the defect with tissue similar to hyaline cartilage, it has the theoretical advantage of being more biological, and mechanically superior, compared with other techniques. In this paper, we describe our experience with autologous chondrocyte transplantation/implantation at the Institute of Orthopedics and Traumatology, Hospital das Clínicas, University of Sâo Paulo, through a report on three cases.